Deerfield Community Center

Adult Friday Night Kickball League 2008

   $20 /person,

  June 13-July 25 (no games on July  4 & 18)

             ** Registration due by May 30, 2008**

 

 

 Player's Name                                                                   Gender______________

Address                                                                               City                                       Zip                           

 Medical Information (Allergies, Asthma, health concerns  etc.)                                                                                        

 Home Phone                                       Cell Phone                                      Email                                                

 Team’s and Manager’s Name___________________________________________________________

Or Individual (will place on team)

 Jersey Size (Please circle one)     Adult sizes :S, M, L, XL, XXL, XXXL, XXXXL, XXXXXL

 Please provide us with your emergency contact information:                                                            

                                                                                              Name and Number

IMPORTANT

Please read and sign the following

I will abide by the rules of the Deerfield Community Center (the "DCC"), its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with youth programs (the "Programs") and in consideration for the DCC accepting the registrant for its Programs and activities, I hereby release, discharge and/or otherwise indemnify the DCC, its affiliated organizations and sponsors, their employees and associated personnel, including the owners of fields and facilities utilized for the Programs, against any claim by or on behalf of the registrant as a result of the registrant’s participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize.

I hereby give consent for emergency medical care given under whatever conditions are necessary to preserve the life, limb or well being of myself.

 

                                                                                                                                                                                               

Printed Name of Participant

 

                                                                                                                                                                                               

Signature                                                                                                                                               Date                                       

 
Text Box: IMPORTANT Please read and sign the following I will abide by the rules of the Deerfield Community Center (the "DCC"), its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with youth programs (the "Programs") and in consideration for the DCC accepting the registrant for its Programs and activities, I hereby release, discharge and/or otherwise indemnify the DCC, its affiliated organizations and sponsors, their employees and associated personnel, including the owners of fields and facilities utilized for the Programs, against any claim by or on behalf of the registrant as a result of the registrant’s participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize. I hereby give consent for emergency medical care given under whatever conditions are necessary to preserve the life, limb or well being of myself.                                                                                                                                                                                                   Printed Name of Participant                                                                                                                                                                                                   Signature                                                                                                                                               Date                                               Return form and Fees to:

Deerfield Community Center at 3 W Deerfield St. or mail to PO Box 404, Deerfield, WI 53531

Text Box: DCC OFFICIAL USE ONLY:   Player fee:                               $                              Added to Database   Late Fee:                  $                Total                       $                              Check #  

 

 

 


 

Make Checks payable to DCC, PO Box 404, Deerfield, WI  53531.  Questions, Call Anne at 764-5935. or dccathletics@yahoo.com.